Intraoperative pH Is a Reliable Prognostic Factor for Patients With Periampullary Carcinoma Undergoing Pancreaticoduodenectomy.

Chao Dang,Tingmei Wang,Renyi Qin,Min Wang

doi:10.3389/fonc.2021.764572

Abstract

A reliable prognostic factor for periampullary carcinoma is critical to improve surgical outcomes. Intraoperative acidosis reflects the incidence of intraoperative adverse events and impact the prognosis. In this study, 612 patients with periampullary carcinoma who underwent pancreaticoduodenectomy (PD) were divided into high- and low-pH groups according to the cut-off value of receiver operating characteristic curve (7.34). Through statistical analysis of the difference between the high- and low-pH group, it was found that the low-pH group had worse short-term prognosis than the high pH group, and intraoperative pH was an independent prognostic factor for patients with periampullary carcinoma undergoing PD. In addition, patients who underwent laparoscopic pancreaticoduodenectomy had a more alkaline pH after surgery. This is of great help for early judgment of short-term and even long-term prognosis of patients with pancreatic cancer after surgery, and can even guide clinicians to improve prognosis by early adjustment of pH value.

Highlights

Periampullary adenocarcinoma, which may originate in the pancreas, distal common bile duct, duodenum, or ampulla, is a common malignancy with an increasing incidence in recent years [1]
The incidence of pancreatic leakage was higher in the low pH group; the patients in this group had longer hospital stays and higher 90-day mortality. These findings indicate that a low intraoperative pH is associated with a poor short-term prognosis
We found that the intraoperative pH was significantly higher in the Laparoscopic pancreaticoduodenectomy (LPD) than open pancreaticoduodenectomy (OPD) group, which was closer to the pH value obtained through receiver operating characteristic (ROC) curve analysis

Summary

Introduction

Periampullary adenocarcinoma, which may originate in the pancreas, distal common bile duct, duodenum, or ampulla, is a common malignancy with an increasing incidence in recent years [1]. Pancreaticoduodenectomy (PD) is a major abdominal procedure for the treatment of periampullary adenocarcinoma, but it has a high inpatient mortality rate [2, 3]. Prediction of postoperative complications and reduction of short-term mortality are important for improving the prognosis of periampullary carcinoma. A low serum pH is associated with increased complications and mortality after major surgery [6, 7]. Intraoperative acidosis reflects the incidence of intraoperative adverse events, and deficient tissue perfusion is an important factor affecting healing. A prolonged duration of pH Is a Prognostic Marker intraoperative hypotension, excessive blood loss, excessive blood transfusion, hypothermia, a long operation time, an improper operative technique, inadequate drug administration, excessive fluid administration, or the occurrence of clinically negligible adverse events can lead to intraoperative metabolic acidosis, which reflects inadequate tissue perfusion [8]. Few studies have addressed the effect of pH on the postoperative complications and prognosis of PD

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Discussion

Conclusion